Seven males with liver cirrhosis associated with hepatitis and one with schistosomal liver fibrosis were studied for hypophyseal gonadal dysfunction and compared to six age matched controls. Cirrhotics as a group had higher serum 17 beta estradiol levels (22.1 +/- 6.3 vs 7.8 +/- 0.8 pg/ml, p less than 0.05) which did not rise after four days of human chorionic gonadotropin (hCG) stimulation. Conversely, there was an adequate rise in serum testosterone level after hCG stimulation (332.8 +/- 99.7 ng/dl baseline to 887.6 +/- 67.1 ng/dl, p less than 0.01). Compared to the controls, cirrhotics had lower baseline serum follicle stimulating hormone (FSH) (3.6 +/- 1.7 vs. 10.2 +/- 1.5 mIu/ml, p less than 0.02) and higher serum prolactin (13.5 +/- 2.5 vs. 6.8 +/- 1.0 ng/ml, p less than 0.05). Pituitary dynamic function testing in cirrhotics revealed blunted response of luteinizing hormone (LH) and FSH, to luteinizing hormone releasing hormone (LHRH) in four out of eight subjects tested. We conclude that the mechanism of hypogonadism in non-alcoholic cirrhosis is mostly hypogonadotropic in origin rather than primary gonadal injury which is common in alcoholic cirrhosis.

Adolescent↗

PubMedDate not supplied

Management of dyslipidemia.

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Adult↗

PubMedDate not supplied

Managing diabetes mellitus in a Lebanese primary care centre. Working towards change.

OBJECTIVES: Demand for medical care in Lebanon is dominated by diseases, such as diabetes. Quality of documentation of care given to these patients in a primary care centre, prior to and after introducing a diabetes initiative (DI) is reported. METHODS: Chart audit of diabetic patients attending an inner city health centre in Beirut, during 1/6/94-30/8/96 was conducted. DI was introduced in 1/1/97, and audit repeated six months later. RESULTS: First and second audits identified 213 and 162 patients respectively. Audit I showed poor recording for almost all parameters; example: family history (3%), smoking status (11%), hypertension (9%), dyslipidaemia (4%), BMI (nil), blood pressure (46%), foot exam (16%), HbA1c (nil), serum cholesterol and triglyceride (27%) and urine analysis (12%). Audit II revealed an improvement in the recording of most parameters, risk factors such as: smoking status, hypertension, hyperlipidaemia (98-99%), physical examination: BMI (39%), foot and peripheral circulation (91-92%), blood pressure (87%). Over half the patients had undergone a complete metabolic workup. CONCLUSION: Over the short period of time, there appears to have been an important improvement in the documentation of medical care for these diabetic patients. Effects of this change in terms of clinical outcomes is currently being assessed.

Diabetes Mellitus↗